What is addiction
Addiction and Substance Use Disorders
How To Help
How Is Addiction Treated?
Related conditions
Family Therapy on Addiction
Find a Treatment Program
9 Facts About Addiction People Usually Get Wrong

What Is Addiction?

Addiction is a condition that results when a person ingests a substance (e.g., alcohol, cocaine, nicotine) or engages in an activity (e.g., gambling, sex, shopping) that can be pleasurable but the continuation of which becomes compulsive and interferes with ordinary responsibilities and concerns, such as work, relationships, or health. People who have developed an addiction may not be aware that their behavior is out of control and causing problems for themselves and others.

The word addiction is used in several different ways. One definition describes physical addiction. This is a biological state in which the body adapts to the presence of a drug so that drug no longer has the same effect, otherwise known as a tolerance. Another form of physical addiction is the phenomenon of overreaction by the brain to drugs (or to cues associated with the drugs). An alcoholic walking into a bar, for instance, will feel an extra pull to have a drink because of these cues.

However, most addictive behavior is not related to either physical tolerance or exposure to cues. People commonly use drugs, gamble, or shop compulsively in reaction to being stressed, whether or not they have a physical addiction. Since these psychologically based addictions are not based on drug or brain effects, they can account for why people frequently switch addictive actions from one drug to a completely different kind of drug, or even to a non-drug behavior. The focus of the addiction isn't what matters; it's the need to take action under certain kinds of stress. Treating this kind of addiction requires an understanding of how it works psychologically.

When referring to any kind of addiction, it is important to recognize that its cause is not simply a search for pleasure and that addiction has nothing to do with one's morality or strength of character. Experts debate whether addiction is a "disease" or a true mental illness, whether drug dependence and addiction mean the same thing, and many other aspects of addiction. Such debates are not likely to be resolved soon. But the lack of resolution does not preclude effective treatment.

Addiction and Substance Use Disorders

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will causes problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.

People can develop an addiction to:

  • Alcohol
  • Marijuana
  • PCP, LSD and other hallucinogens
  • Inhalants, such as, paint thinners and glue
  • Opioid pain killers, such as codeine and oxycodone, heroin
  • Sedatives, hypnotics and anxiolytics (medicines for anxiety such as tranquilizers)
  • Cocaine, methamphetamine and other stimulants
  • Tobacco

People with a substance use disorder have distorted thinking, behavior and body functions. Changes in the brain’s wiring are what cause people to have intense cravings for the drug and make it hard to stop using the drug. Brain imaging studies show changes in the areas of the brain that relate to judgment, decision making, learning, memory and behavior control.

These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug — the intoxication. Intoxication is the intense pleasure, calm, increased senses or a high caused by the drug. Intoxication symptoms are different for each substance.

Over time people with addiction build up a tolerance, meaning they need larger amounts to feel the effects.

According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons, including:

  • to feel good — feeling of pleasure, “high”
  • to feel better — e.g., relieve stress
  • to do better — improve performance
  • curiosity and peer pressure

People with addictive disorders may be aware of their problem, but be unable to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.

Symptoms of substance use disorder are grouped into four categories:

  • Impaired control: a craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use
  • Social problems: substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use
  • Risky use: substance is used in risky settings; continued use despite known problems
  • Drug effects: tolerance (need for larger amounts to get the same effect); withdrawal symptoms (different for each substance)

Many people experience both mental illness and addiction. The mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse.


How Is Addiction Treated?

Effective treatments for addiction are available.

The first step on the road to recovery is recognition of the problem. The recovery process can be hindered when a person denies having a problem and lacks understanding about substance misuse and addiction. The intervention of concerned friends and family often prompts treatment.

A health professional can conduct a formal assessment of symptoms to see if a substance use disorder exists. Even if the problem seems severe, most people with a substance use disorder can benefit from treatment. Unfortunately, many people who could benefit from treatment don’t receive help.

Because addiction affects many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s situation and any co-occurring medical, psychiatric and social problems can lead to sustained recovery.

Medications are used to control drug cravings and relieve severe symptoms of withdrawal. Therapy can help addicted individuals understand their behavior and motivations, develop higher self-esteem, cope with stress and address other mental health problems. Treatment may also include:

  • Hospitalization
  • Therapeutic communities (highly controlled, drug-free environments) or sober houses
  • Outpatient programs

Many people find self-help groups for individuals (Alcoholics Anonymous, Narcotics Anonymous) as well as their family members (Al-Anon or Nar-Anon Family Groups) useful.


Drug addiction is preventable. Drug education and prevention efforts aimed at children and adolescents and involving families, schools, communities and media can be effective in reducing drug misuse.

Risk and Protective Factors for Drug Misuse and Addiction

Aggressive behavior in childhood/Good self-control

Lack of parental supervision/Parental monitoring and support

Poor social skills/Positive relationships

Drug experimentation/Academic competence

Availability of drugs at school/School anti-drug policies

Community poverty/Neighborhood pride

These 13 principles of effective drug addiction treatment were developed based on three decades of scientific research. Research shows that treatment can help drug-addicted individuals stop drug use, avoid relapse and successfully recover their lives.

1. Addiction is a complex, but treatable, disease that affects brain function and behavior.

2. No single treatment is appropriate for everyone.

3. Treatment needs to be readily available.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.

5. Remaining in treatment for an adequate period of time is critical.

6. Counseling— individual and/or group —and other behavioral therapies are the most commonly used forms of drug abuse treatment.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.

8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure it meets his or her changing needs.

9. Many drug-addicted individuals also have other mental disorders.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.

11.Treatment does not need to be voluntary to be effective.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.

13. Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.
Source: National Institute on Drug Abuse. These principles are detailed in NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide.

How to Help a Friend or Family Member

Some suggestions to get started:

Learn all you can about alcohol and drug misuse and addiction.

  • Speak up and offer your support: talk to the person about your concerns, and offer your help and support, including your willingness to go with them and get help. Like other chronic diseases, the earlier addiction is treated, the better.
  • Express love and concern: don’t wait for your loved one to “hit bottom.” You may be met with excuses, denial or anger. Be prepared to respond with specific examples of behavior that has you worried.
  • Don’t expect the person to stop without help: you have heard it before - promises to cut down, stop - but, it doesn’t work. Treatment, support, and new coping skills are needed to overcome addiction to alcohol and drugs.
  • Support recovery as an ongoing process: once your friend or family member is receiving treatment, or going to meetings, remain involved. Continue to show that you are concerned about his/her successful long-term recovery.

Some things you don’t want to do:

  • Don't preach: Don’t lecture, threaten, bribe, preach or moralize.
  • Don't be a martyr: Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.
  • Don't cover up, lie or make excuses for his/her behavior.
  • Don't assume their responsibilities: taking over their responsibilities protects them from the consequences of their behavior.
  • Don't argue when using: avoid arguing with the person when they are using alcohol or drugs; at that point he/she can’t have a rational conversation.
  • Don’t feel guilty or responsible for their behavior; it’s not your fault.
  • Don't join them: don’t try to keep up with them by drinking or using.

Adapted from: National Council on Alcoholism and Drug Dependence

Related Conditions

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder is included in a new category on behavioral addictions. This reflects research findings that gambling disorder is similar to substance-related disorders in many ways. Recognizing these similarities will help people with gambling disorder get needed treatment and services, and may help others better understand the challenges.

  • Internet gaming disorder is included in DSM-5 in the section of disorders requiring further research. This reflects the scientific literature showing that persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. The condition criteria do not include general use of the Internet or social media.
  • Caffeine Use Disorder Caffeine intoxication and caffeine withdrawal are included in DSM-5. Caffeine use disorder, however, is in the section of DSM-5 for conditions requiring further research. While there is evidence to support this as a disorder, experts conclude it is not yet clear to what extent it is a clinically significant disorder.

9 Facts About Addiction People Usually Get Wrong

There’s a lot that people get wrong about substance use disorders, treatment and recovery. Don’t let social judgment or misinformation stand in the way of getting your child the help he or she needs and deserves. We’ve put together 9 facts about addiction so you can be better prepared to help your child.

#1 Fact: Substance use changes the brain, which can make drug use compulsive

An adolescent may start out doing drugs occasionally or may be prescribed medicine by a doctor. Over time, continued use rewires the brain to compulsively seek substances, despite negative consequences. With opioids, a person may initially like the euphoria, but soon, the drug is needed just to feel normal and not get sick from withdrawal. LEARN MORE: Addiction is a chronic medical disease of the brain.

#2 Fact: Expect your child to "just quit" cold turkey is unrealistic

Changing substance use behavior is a process. In the beginning your child may not think there is a problem. Next, she may realize it is a problem, but feel conflicted about addressing it. Then she needs to figure out how to deal with it and take steps in a healthier direction, including getting professional help, changing friends, learning drug refusal skills and more. LEARN MORE: Find out how you can best suggest treatment to your child.

#3 Fact: Intervening early is more effective than waiting for "rock bottom".

Because behavior change is a process, instead of letting your son or daughter hit their lowest point, it's important to help right away. And it is much easier to help when they are still engaged in school or work, have social supports and interested in sports or hobbies. In other words, they have structure, purpose and social connections—scaffolding needed for a good outcome. LEARN MORE: Get one-on-one help and support from our trained and caring master’s-level counselors.

#4 Fact: Your child can be ambivalent about treatment and it can still be effective.

While some welcome the opportunity for treatment, most will be conflicted about stopping their substance use. Studies show those who enter drug treatment programs as a result of loving pressure do comparatively better in treatment, regardless of the reason they sought treatment in the first place. LEARN MORE: Learn how you can address your child’s drug use.

#5 Fact: Relapse is common and represents a learning opportunity.

Relapse doesn't mean that treatment hasn't worked. As with all chronic diseases, many people have one or more relapses before achieving long-lasting recovery. Relapses happen both when the person is doing well or when struggling, and can serve as a learning opportunity to identify what triggered the relapse -- and to find ways to address it for the future. LEARN MORE: Read 5 Things You Need to Know About Relapse.

#6 Fact: Positive behavior and communication skills are more effective than punishment.

Addiction is a brain disease and needs family support as with any other chronic illness. Shaming, detaching or punishing often backfires, with kids spiraling further into risky substance use or isolation. What does work is reinforcing positive behaviors, finding healthy activities that compete with your child's use and letting him or her experience natural consequences. Coupled with empathy and compassion, this approach (known as CRAFT) is a scientifically-proven way to help parents change their child's substance use. LEARN MORE: Use CRAFT skills to help your family heal.

#7 Fact: Finding an effective approach for treatment can mean investigating different doctors or programs before finding a good "match."

The best programs give a screening and in-depth assessment of your child by a qualified professional versed in addiction and mental health. They will develop an individual treatment plan and combine methods tailored to address your child's specific needs. But don't be discouraged if the first program you investigate is not a good fit -- keep exploring other options. LEARN MORE: Find out more in our Treatment eBook.

#8 Fact: Medication-assisted treatment, coupled with counseling, is the preferred treatment for heroin and other opioids

Taking medication for an opioid addiction is like taking medication for any other chronic disease, like diabetes or asthma. Numerous studies have shown that medications can reduce cravings, relapses and overdoses when taken as prescribed. LEARN MORE: Medication-Assisted Treatment can help aid recovery.

#9 Fact: Many people struggling with substance use require longer-term and/or repeated treatment.

Because a drug problem can include relapses, going through treatment once may not be sufficient to keep your child drug free. Each treatment episode allows them to be abstinent for a period of time while learning new coping skills -- but it may take time. Know the treatment options available so that you can make the best choice for your child's path to recovery. LEARN MORE: Get help navigating the treatment system.

Family Therapy on Addiction

Family therapy is of critical importance when treating a teen or young adult with a substance use disorder.

Family Therapy

When addressing substance use, it’s often helpful to look at the family system as it can have a significant impact on how a teen or young adult succeeds in treatment. Family system simply refers to the roles people play in their families and the patterns of interaction with each other.

A “system” is defined as a collection of inter-related and/or inter-dependent parts that comprise a more complex whole.

For example, the human body is comprised of major organ systems such as the respiratory, digestive and immune systems, all which work together to keep the body functioning. Each system depends, directly or indirectly, on all the others to maintain overall health.

The same is true of the family system.

Family therapy (also referred to as family counseling) can strengthen the family system by examining the relationships within it and the family interactions — with the goal of helping family members learn to:

  • Recognize unhealthy patterns of interacting
  • Understand how one’s own behaviors impact others
  • How to set and manage boundaries
  • Communicate more effectively

Here are two examples of my approach to working with families to help illustrate the benefits of this process. Note: the names have been changed.

Meet Devon

Devon is young man in his early 20s admitted into treatment with severe alcohol use disorder and severe cocaine use disorder. Devon drank his first beer at 8 years old and would sneak drinks at family parties. By 13, Devon was drinking alcohol and smoking marijuana several nights per week. By the age of 20, he was using cocaine and alcohol daily.

As a family counselor, I began to examine Devon’s family system; the interactions among Devon, his parents and his three sisters. I needed to determine how I could both support his family and determine what changes needed to occur within the system to support Devon’s recovery.

Like many families, Devon’s family knew very little about the disease of addiction. Devon’s parents assumed that this was just a phase that Devon was going through and that he would emerge relatively unscathed on the other side.

It also became clear that Devon had far less structure than his sisters and, as the only son, was given greater leeway. Devon explained that he got away with far more than he should have been able to and any consequences that he received from his parents were light and often short-lived. Devon said that his family didn’t discuss their feelings and avoided having difficult conversations about his drug and alcohol use. As Devon’s substance use progressed, his parents began to feel a great deal of guilt that they had failed him in some way, and caused his addiction.

During family therapy, I educated the family on the disease model of addiction.

This alleviated much of the parents’ guilt and self-blame regarding their son’s addiction. Devon’s family also learned that Devon would need to take ownership of his own recovery. I recommended Devon’s parents attend Al-anon and focus on changes that they needed to make in their own lives. This included learning how to support Devon’s recovery by establishing and maintaining healthy boundaries. They also began to let him experience the consequences of his actions, letting life teach him lessons rather than intervening to minimize the possible impact on his choices.

Devon reported, however, that the most important part of family counseling was an exercise called the knee-to-knee exercise. This is a structured communication exercise that focuses on expression of emotion and “listening to understand” as opposed to “listening to respond.” Family members complete a written exercise that prompts them to express their feelings regarding a wide variety of their loved one’s behaviors. The family members sit in chairs “knee to knee” and then share their feelings while the other family member listens. Family members are not allowed to respond to what they hear. Removing one’s ability to respond increases the likelihood for genuine listening. Devon was able to truly hear, for the first time, how his actions had truly impacted his family. Devon shared that he had no idea that his drug and alcohol use had caused so much pain and fear in his family.

As family therapy concluded, each family member left with a much clearer understanding of the process of recovery, both in their individual lives and the life of Devon.

Meet Robert

Robert is also a young man in his early 20s who was admitted into treatment with a primary diagnosis of severe alcohol use disorder and severe cocaine use disorder. Robert shared that he drank his first beer when he was 6 and began to use marijuana, cocaine and alcohol by 12.

Robert is an only child from a well-educated, middle-class family. His father is an attorney and his mother is a successful businesswoman. Robert’s parents are very goal-driven and he frequently had a difficult time living up to their standards of perfection. This caused Robert to feel a great deal of shame. Robert grew up not being able to identify his emotions. Expressions of feelings, other than anger and sometimes sadness, were not allowed within his family (an unspoken rule) and so Robert learned to suppress his feelings.

Robert also shared that it was easy to manipulate his mother with respect to his drug use. Robert’s mother would always take his side, mistakes were never his fault, and he rarely, if ever, suffered consequences for the choices he made. This is an example of co-signing unhealthy behavior and it a hallmark of addictive relationships. It is the normalizing or minimizing of unhealthy behaviors and the removal of responsibility for those behaviors. This prevents the person with the disease of addiction from learning from his or her unhealthy choices.

Robert also had deep-seated resentments toward his father. Robert’s father would often be at a favorite bar instead of attending Robert’s hockey games and Robert could never get the validation that he so desperately craved from his father. This emotional distancing between father and son also reinforced his mother’s unhealthy closeness and the sense that he could “do no wrong” in his her eyes.

There were many goals for family therapy. We had to examine and replace the unspoken family rules within the family system that created problems.

All family members needed to learn how to identify their emotions. Furthermore, an open line of communication, particularly on an emotional level, had to be established. This allowed Robert to express what his emotional needs were and to work through the resentments that he had with his father.

Robert’s mother also had to examine her behaviors; particularly where she was not honoring boundaries and not following through on consequences for her son.

It emerged in counseling that Robert’s grandfather on his mom’s side had the disease of alcoholism and that this fueled her need to soften or block any consequences her son might experience related to his substance use. She was attempting to heal wounds from her childhood in her relationship with Robert.

As the family system began to operate in a healthier manner, Robert began to get his emotional needs met in a way that he never had previously. Robert was also allowed to take ownership of the decisions that he made and to experience the natural consequence of poor decisions without being rescued or shamed. This eventually led to Robert making healthier choices and his recovery from his substance use disorder began to thrive.

Unfortunately, when families are unwilling to engage in this journey with their loved one, the outcomes aren’t usually as positive. The son or daughter with the addiction often becomes the focal point that distracts the family from looking at other problems within the family system.

However, when families are courageous enough to engage in the difficult task of family counseling, the changes can be extensive and beneficial.

Family therapy can not only breathe new life into the family, it can also significantly impact the recovery process for the teen or young adult struggling with the substance use disorder.


Substance Abuse and Mental Health Services Administration (SAMHSA)
National Institute on Drug Abuse: Drugs, Brains, and Behavior – The Science of Addiction
National Council on Alcoholism and Drug Dependence
National Center on Addiction and Substance Abuse at Columbia University
Alcoholics Anonymous
Narcotics Anonymous